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Igwe I, Onyeneho N, Okeibunor JC, Yao MNK, Diarra T, Djingarey MH, Fall S, Gueye AS. Perceptions and Rumors About the Ebola Virus Disease Vaccine in the Ituri and Kivu Provinces of the Democratic Republic of Congo. J Immunol Sci 2023; Suppl 3:58-68. [PMID: 38333356 PMCID: PMC7615612 DOI: 10.29245/2578-3009/2023/s3.1111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
Perceptions and rumors about vaccinations can contribute to vaccine hesitancy. This study aimed to examine perceptions and rumors about the Ebola vaccine during the 10th Ebola Virus Disease outbreak in the Ituri and North Kivu provinces of the Democratic Republic of Congo. Eight hundred randomly selected respondents were surveyed with a uniform structured questionnaire. Further, we collected qualitative data through focus group discussions and using in-depth interview guides. Results revealed several misperceptions and rumors about the vaccine, which led to some level of vaccine hesitancy and refusal among the people. The acceptance rate of the vaccine was 67.3% (below the 80% threshold needed to create herd immunity in the population). More of the urban population (31.3%) than the rural population (10.4%) accepted the vaccine. Refusals were largely due to fear that the vaccine could activate other diseases in the body and could even kill. Some feared that it was a conspiracy of the government to reduce the population in the study area through forced fertility control and death, among other such concerns. In conclusion, these rumors increased mistrust, which challenged the efforts of the government and its partners to safeguard the health of the people.
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Quadri MFA, Lusher J, Folayan MO, Tantawi ME, Zuñiga AA, Brown B, Aly NM, Okeibunor JC, Florencia G, Jafer M, Ara E, Miranda KA, Al-Khanati NM, Ellakany P, Gaffar B, Ishabiyi AO, Khan AT, Khalid Z, Lawal FB, Nzimande N, Shamala A, Al-Tammemi AB, Osamika BE, Yousaf MA, Virtanen JI, Nguyen AL. Factors associated with an increase in tobacco use and alcohol drinking during the COVID-19 pandemic: A cross-sectional study of data from 105 countries. Tob Induc Dis 2023; 21:14. [PMID: 36741539 PMCID: PMC9881585 DOI: 10.18332/tid/157205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 10/25/2022] [Accepted: 12/06/2022] [Indexed: 01/29/2023] Open
Abstract
INTRODUCTION The COVID-19 pandemic has inevitably led to monumental challenges, and alcohol drinking and tobacco use have unlikely been spared. This cross-sectional survey reports on factors associated with an increase in alcohol drinking and tobacco use during the COVID-19 pandemic. METHODS An online survey conducted in 2020, generated data from 14899 adults residing in 105 countries. Dependent variables were changes in alcohol drinking and tobacco use. Independent variables were age, sex, education level, job loss, lost or reduced wages, investment/retirement benefits, interrupted substance addiction care, and income level of the countries. Multilevel logistic regression analysis was computed to explore the associations between dependent and independent variables in adjusted models using the backward stepwise method. The probability of including or excluding a covariate was set at p(in)<0.05 and p(out)>0.1, respectively. RESULTS Of the regular alcohol consumers (N=4401), 22.9% reported an increase in their alcohol drinking. Of the regular tobacco users (N=2718), 31% reported an increase in their tobacco use. Job loss (Alcohol: AOR=1.26; Tobacco: AOR=1.32) and lost/reduced wages (Alcohol: AOR=1.52; Tobacco: AOR=1.52) were associated with higher odds of increased alcohol drinking and tobacco use. Many interruptions to addiction care (AOR=1.75) were associated with higher odds of increased alcohol drinking. Whereas no interruption to addiction care was associated with lower odds of increased alcohol drinking (AOR=0.77). Also, none (AOR=0.66) or some (AOR=0.70) interruptions to addiction care were associated with lower odds of increased tobacco use. CONCLUSIONS This global survey alludes to the unintended consequences of the current COVID-19 pandemic on alcohol drinking and tobacco use. It is critical that the strategies for emergency responses should include support to ameliorate the impact of financial distress and disruption in substance dependence treatment services.
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Affiliation(s)
- Mir Faeq A. Quadri
- Dental Public Health Division, College of Dentistry, Jazan University, Jazan, Saudi Arabia,Department of Oral Health Sciences, School of Dentistry, University of Washington, Seattle, United States
| | | | - Morenike O. Folayan
- Department of Child Dental Health, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Maha El Tantawi
- Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | | | - Brandon Brown
- Department of Social Medicine, Population and Public Health, University of California Riverside School of Medicine, Riverside, United States
| | - Nourhan M. Aly
- Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Joseph C. Okeibunor
- World Health Organization - Regional Office for Africa, Brazzaville, Republic of Congo
| | | | - Mohammed Jafer
- Department of Health Promotion, Maastricht University, Maastricht, The Netherlands
| | - Eshrat Ara
- Department of Psychology, Government College for Women, Cluster University of Srinagar, Srinagar, India
| | - Kessketlen A. Miranda
- Research Centre in Physical Activity, Health and Leisure, University of Porto, Porto, Portugal
| | - Nuraldeen M. Al-Khanati
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Syrian Private University, Damascus, Syria
| | - Passent Ellakany
- Department of Substitutive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
| | - Balgis Gaffar
- Department of Preventive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
| | - Anthonia O. Ishabiyi
- Migration Health Division, International Organization for Migration, United Nations Migration Agency, Amman, Jordan,Applied Science Research Center, Applied Science Private University, Amman, Jordan
| | - Abeedha T. Khan
- School of Biological Sciences, University of the Punjab, Lahore, Pakistan
| | - Zumama Khalid
- Department of Health Sciences, University of Genova, Genova, Italy
| | - Folake B. Lawal
- Department of Periodontology and Community Dentistry, University of Ibadan, Ibadan, Nigeria
| | - Ntombifuthi Nzimande
- Department of Economic and Human Geography, University of Szeged, Szeged, Hungary
| | - Anas Shamala
- Department of Preventive and Biomedical Science, Faculty of Dentistry, University of Science and Technology, Sana'a, Yemen
| | - Ala’a B. Al-Tammemi
- Migration Health Division, International Organization for Migration, United Nations Migration Agency, Amman, Jordan,Applied Science Research Center, Applied Science Private University, Amman, Jordan
| | | | - Muhammad A. Yousaf
- Institute of Zoology, University of the Punjab, Lahore, Pakistan,Department of Biology, Virtual University of Pakistan, Lahore, Pakistan
| | | | - Annie L. Nguyen
- Department of Family Medicine, Keck School of Medicine, University of Southern California, Los Angeles, United States
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Karamagi HC, Muneene D, Droti B, Jepchumba V, Okeibunor JC, Nabyonga J, Asamani JA, Traore M, Kipruto H. eHealth or e-Chaos: The use of Digital Health Interventions for Health Systems Strengthening in sub-Saharan Africa over the last 10 years: A scoping review. J Glob Health 2022; 12:04090. [PMID: 36462201 PMCID: PMC9718445 DOI: 10.7189/jogh.12.04090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Background Digital health solutions are a potent and complementary intervention in health system strengthening to accelerate universal access to health services. Implementing scalable, sustainable, and integrated digital solutions in a coordinated manner is necessary to experience the benefits of digital interventions in health systems. We sought to establish the breadth and scope of available digital health interventions (DHIs) and their functions in sub-Saharan Africa. Methods We conducted a scoping review according to the Joanne Briggs Institute's reviewers manual and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses - Extension for Scoping Reviews (PRISMA-ScR) checklist and explanation. We retrieved data from the WHO Digital Health Atlas (DHA), the WHO e-Health country profiles report of 2015, and electronic databases. The protocol has been deposited in an open-source platform - the Open Science Framework at https://osf.io/5kzq7. Results The researchers retrieved 983 digital tools used to strengthen health systems in sub-Saharan Africa over the past 10 years. We included 738 DHIs in the analysis while 245 were excluded for not meeting the inclusion criteria. We observed a disproportionate distribution of DHIs towards service delivery (81.7%, n = 603), health care providers (91.8%, n = 678), and access and use of information (84.1%, n = 621). Fifty-three percent (53.4%, n = 394) of the solutions are established and 47.5% (n = 582) were aligned to 20% (n = 5) of the system categories. Conclusions Sub-Saharan Africa is endowed with digital health solutions in both numbers and distinct functions. It is lacking in coordination, integration, scalability, sustainability, and equitable distribution of investments in digital health. Digital health policymakers in sub-Saharan Africa need to urgently institute coordination mechanisms to terminate unending duplication and disjointed vertical implementations and manage solutions for scale. Central to this would be to build digital health leadership in countries within SSA, adopt standards and interoperability frameworks; advocate for more investments into lagging components, and promote multi-purpose solutions to halt the seeming "e-chaos" and progress to sustainable e-health solutions.
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Affiliation(s)
- Humphrey C Karamagi
- World Health Organization – Regional Office for Africa, Brazzaville, Republic of Congo
| | | | - Benson Droti
- World Health Organization – Regional Office for Africa, Brazzaville, Republic of Congo
| | | | - Joseph C Okeibunor
- World Health Organization – Regional Office for Africa, Brazzaville, Republic of Congo
| | - Juliet Nabyonga
- World Health Organization, Harare, Zimbabwe,North-West University, Potchefstroom, Mahikeng, Vanderbijlpark, South Africa
| | | | - Moussa Traore
- World Health Organization, Ouagadougou, Burkina Faso
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Ngoy N, Conteh IN, Oyugi B, Abok P, Kobie A, Phori P, Hamba C, Ejiofor NE, Fitzwanga K, Appiah J, Edwin A, Fawole T, Kamara R, Cihambanya LK, Mzozo T, Ryan C, Braka F, Yoti Z, Kasolo F, Okeibunor JC, Gueye AS. Coordination and Management of COVID-19 in Africa through Health Operations and Technical Expertise Pillar: A Case Study from WHO AFRO One Year into Response. Trop Med Infect Dis 2022; 7:tropicalmed7080183. [PMID: 36006275 PMCID: PMC9415043 DOI: 10.3390/tropicalmed7080183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 01/19/2022] [Accepted: 01/26/2022] [Indexed: 11/24/2022] Open
Abstract
Background: following the importation of the first Coronavirus disease 2019 (COVID-19) case into Africa on 14 February 2020 in Egypt, the World Health Organisation (WHO) regional office for Africa (AFRO) activated a three-level incident management support team (IMST), with technical pillars, to coordinate planning, implementing, supervision, and monitoring of the situation and progress of implementation as well as response to the pandemic in the region. At WHO AFRO, one of the pillars was the health operations and technical expertise (HOTE) pillar with five sub-pillars: case management, infection prevention and control, risk communication and community engagement, laboratory, and emergency medical team (EMT). This paper documents the learnings (both positive and negative for consideration of change) from the activities of the HOTE pillar and recommends future actions for improving its coordination for future emergencies, especially for multi-country outbreaks or pandemic emergency responses. Method: we conducted a document review of the HOTE pillar coordination meetings’ minutes, reports, policy and strategy documents of the activities, and outcomes and feedback on updates on the HOTE pillar given at regular intervals to the Regional IMST. In addition, key informant interviews were conducted with 14 members of the HOTE sub pillar. Key Learnings: the pandemic response revealed that shared decision making, collaborative coordination, and planning have been significant in the COVID-19 response in Africa. The HOTE pillar’s response structure contributed to attaining the IMST objectives in the African region and translated to timely support for the WHO AFRO and the member states. However, while the coordination mechanism appeared robust, some challenges included duplication of coordination efforts, communication, documentation, and information management. Recommendations: we recommend streamlining the flow of information to better understand the challenges that countries face. There is a need to define the role and responsibilities of sub-pillar team members and provide new team members with information briefs to guide them on where and how to access internal information and work under the pillar. A unified documentation system is important and could help to strengthen intra-pillar collaboration and communication. Various indicators should be developed to constantly monitor the HOTE team’s deliverables, performance and its members.
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Affiliation(s)
- Nsenga Ngoy
- World Health Organisation, Regional Office for Africa, Emergency Preparedness and Response Programme, Cité du Djoué, Brazzaville P.O. Box 06, Congo
| | - Ishata Nannie Conteh
- World Health Organisation, Regional Office for Africa, Emergency Preparedness and Response Programme, Cité du Djoué, Brazzaville P.O. Box 06, Congo
| | - Boniface Oyugi
- World Health Organisation, Regional Office for Africa, Emergency Preparedness and Response Programme, Cité du Djoué, Brazzaville P.O. Box 06, Congo
- Centre for Health Services Studies (CHSS), University of Kent, George Allen Wing, Canterbury CT2 7NF, UK
| | - Patrick Abok
- World Health Organisation, Regional Office for Africa, Emergency Preparedness and Response Programme, Cité du Djoué, Brazzaville P.O. Box 06, Congo
| | - Aminata Kobie
- World Health Organisation, Regional Office for Africa, Emergency Preparedness and Response Programme, Cité du Djoué, Brazzaville P.O. Box 06, Congo
| | - Peter Phori
- World Health Organisation, Regional Office for Africa, Emergency Preparedness and Response Programme, Cité du Djoué, Brazzaville P.O. Box 06, Congo
| | - Cephas Hamba
- World Health Organisation, Regional Office for Africa, Emergency Preparedness and Response Programme, Cité du Djoué, Brazzaville P.O. Box 06, Congo
| | - Nonso Ephraim Ejiofor
- World Health Organisation, Regional Office for Africa, Emergency Preparedness and Response Programme, Cité du Djoué, Brazzaville P.O. Box 06, Congo
| | - Kaizer Fitzwanga
- World Health Organisation, Regional Office for Africa, Emergency Preparedness and Response Programme, Cité du Djoué, Brazzaville P.O. Box 06, Congo
| | - John Appiah
- World Health Organisation, Regional Office for Africa, Emergency Preparedness and Response Programme, Cité du Djoué, Brazzaville P.O. Box 06, Congo
| | - Ama Edwin
- World Health Organisation, Regional Office for Africa, Emergency Preparedness and Response Programme, Cité du Djoué, Brazzaville P.O. Box 06, Congo
| | - Temidayo Fawole
- World Health Organisation, Regional Office for Africa, Emergency Preparedness and Response Programme, Cité du Djoué, Brazzaville P.O. Box 06, Congo
| | - Rashidatu Kamara
- World Health Organisation, Regional Office for Africa, Emergency Preparedness and Response Programme, Cité du Djoué, Brazzaville P.O. Box 06, Congo
| | - Landry Kabego Cihambanya
- World Health Organisation, Regional Office for Africa, Emergency Preparedness and Response Programme, Cité du Djoué, Brazzaville P.O. Box 06, Congo
| | - Tasiana Mzozo
- World Health Organisation, Regional Office for Africa, Emergency Preparedness and Response Programme, Nairobi Hub, United Nations Office in Nairobi UN Avenue Gigiri, Nairobi 00100, Kenya
| | - Caroline Ryan
- World Health Organisation, Regional Office for Africa, Emergency Preparedness and Response Programme, Nairobi Hub, United Nations Office in Nairobi UN Avenue Gigiri, Nairobi 00100, Kenya
| | - Fiona Braka
- World Health Organisation, Regional Office for Africa, Emergency Preparedness and Response Programme, Cité du Djoué, Brazzaville P.O. Box 06, Congo
| | - Zabulon Yoti
- World Health Organisation, Regional Office for Africa, Emergency Preparedness and Response Programme, Cité du Djoué, Brazzaville P.O. Box 06, Congo
| | - Francis Kasolo
- World Health Organisation, Regional Office for Africa, Emergency Preparedness and Response Programme, Cité du Djoué, Brazzaville P.O. Box 06, Congo
| | - Joseph C. Okeibunor
- World Health Organisation, Regional Office for Africa, Emergency Preparedness and Response Programme, Cité du Djoué, Brazzaville P.O. Box 06, Congo
- Correspondence:
| | - Abdou Salam Gueye
- World Health Organisation, Regional Office for Africa, Emergency Preparedness and Response Programme, Cité du Djoué, Brazzaville P.O. Box 06, Congo
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Mihigo RM, Okeibunor JC, Karmal F, O'Malley H, Godinho N, Okero L, Poy AN, Onyango O, Fitzgerald N. The Addis Declaration on Immunization: A binding reminder of the political support needed to achieve universal immunization in Africa. Vaccine 2022; 40:5126-5130. [PMID: 35871874 DOI: 10.1016/j.vaccine.2022.06.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 05/16/2022] [Accepted: 06/23/2022] [Indexed: 11/28/2022]
Abstract
While African countries have improved access to immunization since the start of the millennium, progress has stagnated in the last few years. One in five African children is not vaccinated with life-saving vaccines, and recent outbreaks of vaccine-preventable diseases (VPDs) including yellow fever, measles, and meningitis, among others point to gaps in immunization coverage as well as disease surveillance. In 2017, African Heads of State endorsed the Addis Declaration on Immunization (ADI) at the 28th African Union Summit and committed to ensuring universal access to immunization across the continent. Since then, countries have taken several steps to translate the ADI commitments into tangible progress. However, the continent continues to face challenges in delivering immunization services, including limited vaccine-related funding, inequitable access to immunization services and weak surveillance systems. In the absence of concerted political will, COVID-19 threatens to reverse progress made so far. This paper reflects on the effects of political will in shaping the immunization agenda on the continent and the continued need for political commitment to deliver on the ADI commitments in a post-COVID world. Data were gathered from the regular national immunization reports, WHO/UNICEF estimates of immunization coverage as well as case studies of country implementation on ADI.
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Nnaji CA, Wiysonge CS, Okeibunor JC, Malinga T, Adamu AA, Tumusiime P, Karamagi H. Implementation research approaches to promoting universal health coverage in Africa: a scoping review. BMC Health Serv Res 2021; 21:414. [PMID: 33941178 PMCID: PMC8094606 DOI: 10.1186/s12913-021-06449-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 04/27/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Implementation research has emerged as part of evidence-based decision-making efforts to plug current gaps in the translation of research evidence into health policy and practice. While there has been a growing number of initiatives promoting the uptake of implementation research in Africa, its role and effectiveness remain unclear, particularly in the context of universal health coverage (UHC). Hence, this scoping review aimed to identify and characterise the use of implementation research initiatives for assessing UHC-related interventions or programmes in Africa. METHODS The review protocol was developed based on the methodological framework proposed by Arksey and O'Malley, as enhanced by the Joanna Briggs Institute. The review is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR). MEDLINE, Scopus and the Cochrane Library were searched. The search also included a hand search of relevant grey literature and reference lists. Literature sources involving the application of implementation research in the context of UHC in Africa were eligible for inclusion. RESULTS The database search yielded 2153 records. We identified 12 additional records from hand search of reference lists. After the removal of duplicates, we had 2051 unique records, of which 26 studies were included in the review. Implementation research was used within ten distinct UHC-related contexts, including HIV; maternal and child health; voluntary male medical circumcision; healthcare financing; immunisation; healthcare data quality; malaria diagnosis; primary healthcare quality improvement; surgery and typhoid fever control. The consolidated framework for implementation research (CFIR) was the most frequently used framework. Qualitative and mixed-methods study designs were the commonest methods used. Implementation research was mostly used to guide post-implementation evaluation of health programmes and the contextualisation of findings to improve future implementation outcomes. The most commonly reported contextual facilitators were political support, funding, sustained collaboration and effective programme leadership. Reported barriers included inadequate human and other resources; lack of incentives; perception of implementation as additional work burden; and socio-cultural barriers. CONCLUSIONS This review demonstrates that implementation research can be used to achieve UHC-related outcomes in Africa. It has identified important facilitators and barriers to the use of implementation research for promoting UHC in the region.
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Affiliation(s)
- Chukwudi A Nnaji
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa.
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
| | - Charles S Wiysonge
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Joseph C Okeibunor
- Health Systems and Services Cluster, World Health Organization Regional Office for Africa, Brazzaville, Congo
| | - Thobile Malinga
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Abdu A Adamu
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Prosper Tumusiime
- Health Systems and Services Cluster, World Health Organization Regional Office for Africa, Brazzaville, Congo
| | - Humphrey Karamagi
- Health Systems and Services Cluster, World Health Organization Regional Office for Africa, Brazzaville, Congo
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Amazigo UV, Leak SGA, Zoure HGM, Okoronkwo C, Diop Ly M, Isiyaku S, Crump A, Okeibunor JC, Boatin B. Community-directed distributors-The "foot soldiers" in the fight to control and eliminate neglected tropical diseases. PLoS Negl Trop Dis 2021; 15:e0009088. [PMID: 33661903 PMCID: PMC7932156 DOI: 10.1371/journal.pntd.0009088] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The neglected tropical diseases (NTDs) affect hundreds of millions of people, predominantly in rural, often difficult-to-access areas, poorly served by national health services. Here, we review the contributions of 4.8 million community-directed distributors (CDDs) of medicines over 2 decades in 146,000 communities in 27 sub-Saharan African countries to control or eliminate onchocerciasis and lymphatic filariasis (LF). We examine their role in the control of other NTDs, malaria, HIV/AIDS interventions, immunisation campaigns, and support to overstretched health service personnel. We are of the opinion that CDDs as community selected, trained, and experienced “foot soldiers,” some of whom were involved in the Ebola outbreak responses at the community level in Liberia, if retrained, can assist community leaders and support health workers (HWs) in the ongoing Coronavirus Disease 2019 (COVID-19) crisis. The review highlights the improved treatment coverage where there are women CDDs, the benefits and lessons from the work of CDDs, their long-term engagement, and the challenges they face in healthcare delivery. It underscores the value of utilising the CDD model for strong community engagement and recommends the model, with some review, to hasten the achievement of the NTD 2030 goal and assist the health system cope with evolving epidemics and other challenges. We propose that, based on the unprecedented progress made in the control of NTDs directly linked to community engagement and contributions of CDDs “foot soldiers,” they deserve regional and global recognition. We also suggest that the World Health Organization (WHO) and other international stakeholders promote policy and guidance for countries to adapt this model for the elimination of NTDs and to strengthen national health services. This will enhance the accomplishment of some Sustainable Development Goals (SDGs) by 2030 in sub-Saharan Africa. Community-directed distributors (CDDs), sometimes known as community health workers (CHWs), have proved to be critical in the delivery of medicines and other tools for the control of neglected tropical diseases (NTDs), prevention of malaria, and other beneficial health interventions. The distributors are the unsung heroes and heroines without whom the health of hundreds of thousands of communities in rural Africa would be worse than it is today. In this paper, we document more than 2 decades (1997–2019) of the contributions of 146,000 communities and 4.8 million CDDs of medicines for NTDs, unpaid or minimally compensated, some have provided 18 years of uninterrupted service. We report on the burden of work and their perspectives of the challenges involved in mass drug administration (MDA) across 27 countries in sub-Saharan Africa. We suggest that they have not been adequately recognised and that harnessing such community human resources could contribute to improving health system’s responses to the ongoing Coronavirus Disease 2019 (COVID-19) crisis. We recommend policy measures for a wider application of existing networks of CDDs by countries’ health systems to consolidate and accelerate the achievements made as well as for the attainment of the goals set forth in the newly developed World Health Organization (WHO) NTD Roadmap.
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Affiliation(s)
- Uche V. Amazigo
- African Programme for Onchocerciasis Control, World Health Organization, Enugu, Nigeria
- * E-mail:
| | - Stephen G. A. Leak
- African Programme for Onchocerciasis Control, World Health Organization, Macclesfield, Cheshire, United Kingdom
| | | | | | | | | | | | | | - Boakye Boatin
- Onchocerciasis Control Programme in West Africa, World Health Organization, Accra, Ghana
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Cooper S, Okeibunor JC, Wiyeh A, Wiysonge CS. Knowledge advances and gaps on the demand side of vaccination. Lancet Infect Dis 2020; 19:13-15. [PMID: 30587281 DOI: 10.1016/s1473-3099(18)30733-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Accepted: 11/22/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Sara Cooper
- Cochrane South Africa, South African Medical Research Council, 7501 Cape Town, South Africa; School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
| | | | - Alison Wiyeh
- Cochrane South Africa, South African Medical Research Council, 7501 Cape Town, South Africa
| | - Charles S Wiysonge
- Cochrane South Africa, South African Medical Research Council, 7501 Cape Town, South Africa; School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa; Department of Global Health, Stellenbosch University, Cape Town, South Africa
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Chukwu NE, Okoye UO, Onyeneho NG, Okeibunor JC. Coping strategies of families of persons with learning disability in Imo state of Nigeria. J Health Popul Nutr 2019; 38:9. [PMID: 30917876 PMCID: PMC6436209 DOI: 10.1186/s41043-019-0168-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 03/18/2019] [Indexed: 05/28/2023]
Abstract
BACKGROUND Coping with a relative with a learning disability could be a stressful experience for family members. The present study is aimed at exploring the coping strategies adopted by families in trying to make meaning of their situation. METHOD A qualitative study design using focus group discussions (FGDs) was adopted. Ten FGD sessions were held with family members of persons with a learning disability. RESULTS Findings revealed patterns of family coping to include problem-focused, emotion-focused, and spiritual/religious-focused. Also, coping responses to a learning disability varied based on the level of information available to families about the condition of their relative. In some cases, interspousal relationship was strained due to stress. CONCLUSION It was recommended that families of persons with a learning disability need social support and professional help from social workers to facilitate the adoption of more positive-oriented coping strategies by family members.
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Affiliation(s)
- Ngozi E. Chukwu
- Department of Social Work, University of Nigeria, Nsukka, Enugu State Nigeria
| | - Uzoma O. Okoye
- Department of Social Work, University of Nigeria, Nsukka, Enugu State Nigeria
| | - Nkechi G. Onyeneho
- Department of Sociology/Anthropology, University of Nigeria, Nsukka, Enugu State Nigeria
- Takemi Program in International Health, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA USA
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Okeibunor JC, Ogbuanu I, Blanche A, Chiwaya K, Chirwa G, Machekanyanga Z, Mihigo R, Zawaira F. Towards a Strategy for Reducing Missed Opportunities for Vaccination in Malawi: Implications of a Qualitative Health Facility Assessment. J Immunol Sci 2018; Suppl:46-54. [PMID: 30766974 PMCID: PMC6372063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Missed opportunities for vaccination (MOVs), estimated to be about 32-47% of child healthcare clinic visits in various settings globally, contribute to unfulfilled childhood vaccination coverage targets in the African region. OBJECTIVE We assessed the extent of MOVs, identify local drivers and test interventions to reduce MOVs in Malawi. METHODS We conducted in-depth and key informant interviews with administrators of district hospitals and officers in charge of community health facilities. Focus group discussions were held with health workers and caregivers of children under 24 months of age who received services from study health facilities in Malawi. Coverage rates were collected from the health facility records. RESULTS Vaccination is appreciated in the communities, but coverage is generally below targets. In some facilities, reported coverage was less than 50%. Opportunities to provide up-to-date vaccination for children were missed due to lack of awareness and knowledge of health workers and caregivers, attitude and priority of health workers, long waiting time, poor coordination and referral of eligible children by clinicians and nurses and overall lack of a team approach to vaccination perceived as a responsibility of health surveillance assistants. Other notable issues included limited time of caregivers labouring on estate farms, unavailability of vaccines resulting from poorly functioning of cold chain equipment and limited transport and failure to appreciate the impact of MOV on poor immunization coverage. CONCLUSION Simple, low-cost, pragmatic and community-driven interventions that may reduce MOVs and improve vaccine coverage.
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Nahimana MR, Nyandwi A, Muhimpundu MA, Olu O, Condo JU, Rusanganwa A, Koama JB, Ngoc CT, Gasherebuka JB, Ota MO, Okeibunor JC. A population-based national estimate of the prevalence and risk factors associated with hypertension in Rwanda: implications for prevention and control. BMC Public Health 2017; 18:2. [PMID: 28693458 PMCID: PMC5504833 DOI: 10.1186/s12889-017-4536-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 06/22/2017] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Hypertension is a leading cause of cardiovascular diseases and a growing public health problem in many developed and developing countries. However, population-based data to inform policy development are scarce in Rwanda. This nationally representative study aimed to determine population-based estimates of the prevalence and risk factors associated with hypertension in Rwanda. METHODS We conducted secondary epidemiological analysis of data collected from a cross-sectional population-based study to assess the risk factors for NCDs using the WHO STEPwise approach to Surveillance of non-communicable diseases (STEPS). Adjusted odds ratios at 95% confidence interval were used to establish association between hypertension, socio-demographic characteristics and health risk behaviors. RESULTS Of the 7116 study participants, 62.8% were females and 38.2% were males. The mean age of study participants was 35.3 years (SD 12.5). The overall prevalence of hypertension was 15.3% (16.4% for males and 14.4% for females). Twenty two percent of hypertensive participants were previously diagnosed. A logistic regression model revealed that age (AOR: 8.02, 95% CI: 5.63-11.42, p < 0.001), living in semi-urban area (AOR: 1.30, 95% CI: 1.01-1.67, p = 0.040) alcohol consumption (AOR: 1.24, 95% CI: 1.05-1.44, p = 0.009) and, raised BMI (AOR: 3.93, 95% CI: 2.54-6.08, p < 0.001) were significantly associated with hypertension. The risk of having hypertension was 2 times higher among obese respondents (AOR: 3.93, 95% CI: 2.54-6.08, p-value < 0.001) compared to those with normal BMI (AOR: 1.74, 95% CI: 1.30-2.32, p-value < 0.001). Females (AOR: 0.75, 95% CI: 0.63-0.88, p < 0.001) and students (AOR: 0.45, 95% CI: 0.25-0.80, p = 0.007) were less likely to be hypertensive. CONCLUSION The findings of this study indicate that the prevalence of hypertension is high in Rwanda, suggesting the need for prevention and control interventions aimed at decreasing the incidence taking into consideration the risk factors documented in this and other similar studies.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Martin O Ota
- WHO Regional Office for Africa, Brazzaville, Congo
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12
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Adejumo AO, Azuogu B, Okorie O, Lawal OM, Onazi OJ, Gidado M, Daniel OJ, Okeibunor JC, Klinkenberg E, Mitchell EMH. Community referral for presumptive TB in Nigeria: a comparison of four models of active case finding. BMC Public Health 2016; 16:177. [PMID: 26905034 PMCID: PMC4763441 DOI: 10.1186/s12889-016-2769-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 01/22/2016] [Indexed: 11/10/2022] Open
Abstract
Background Engagement of communities and civil society organizations is a critical part of the Post-2015 End TB Strategy. Since 2007, many models of community referral have been implemented to boost TB case detection in Nigeria. Yet clear insights into the comparative TB yield from particular approaches have been limited. Methods We compared four models of active case finding in three Nigerian states. Data on presumptive TB case referral by community workers (CWs), TB diagnoses among referred clients, active case finding model characteristics, and CWs compensation details for 2012 were obtained from implementers and CWs via interviews and log book review. Self-reported performance data were triangulated against routine surveillance data to assess concordance. Analysis focused on assessing the predictors of presumptive TB referral. Results CWs referred 4–22 % of presumptive TB clients tested, and 4–24 % of the total TB cases detected. The annual median referral per CW ranged widely among the models from 1 to 48 clients, with an overall average of 13.4 referrals per CW. The highest median referrals (48 per CW/yr) and mean TB diagnoses (7.1/yr) per CW (H =70.850, p < 0.001) was obtained by the model with training supervision, and $80/quarterly payments (Comprehensive Quotas-Oriented model). The model with irregularly supervised, trained, and compensated CWs contributed the least to TB case detection with a median of 13 referrals per CW/yr and mean of 0.53 TB diagnoses per CW/yr. Hours spent weekly on presumptive TB referral made the strongest unique contribution (Beta = 0.514, p < 0.001) to explaining presumptive TB referral after controlling for other variables. Conclusion All community based TB case-finding projects studied referred a relative low number of symptomatic individuals. The study shows that incentivized referral, appropriate selection of CWs, supportive supervision, leveraged treatment support roles, and a responsive TB program to receive clients for testing were the key drivers of community TB case finding.
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Affiliation(s)
- A O Adejumo
- Department of Community Health and Primary Health Care, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria.
| | - B Azuogu
- Department of Community Medicine, Ebonyi State University, Abakaliki, Nigeria
| | - O Okorie
- Abia State TB and Leprosy Control Programme, Umuahia, Abia, Nigeria
| | - O M Lawal
- Oyo State TB and Leprosy Control programme, Ibadan, Oyo, Nigeria
| | | | | | - O J Daniel
- Department of Community Medicine and Primary Care, Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun, Nigeria
| | - J C Okeibunor
- Department of Sociology/Anthropology, University of Nigeria, Nsukka, Enugu, Nigeria
| | - E Klinkenberg
- KNCV Tuberculosis Foundation, the Hague, The Netherlands.,Department of Global Health, Academic Medical Center, Amsterdam Institute of Global Health and Development, Amsterdam, The Netherlands
| | - E M H Mitchell
- KNCV Tuberculosis Foundation, the Hague, The Netherlands.,Department of Global Health, Academic Medical Center, Amsterdam Institute of Global Health and Development, Amsterdam, The Netherlands
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13
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Onyeneho NG, Amazigo UV, Njepuome NA, Nwaorgu OC, Okeibunor JC. Perception and utilization of public health services in Southeast Nigeria: Implication for health care in communities with different degrees of urbanization. Int J Equity Health 2016; 15:12. [PMID: 26791575 PMCID: PMC4721046 DOI: 10.1186/s12939-016-0294-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 01/05/2016] [Indexed: 11/18/2022] Open
Abstract
Background The relationship between people’s perception and utilization of public health serviceswas investigated. Methods A survey of 840 households across selected urban, peri urban and rural communities, in the Southeast of Nigeria, was conducted using the mixed methods approach. Results Of the nine (9) demographic variables, only the locality and status of the health system (strong or weak in terms of child immunization) was found to influence both the poor rating and utilization of public health services. Individuals from states with strong health system rated relatively higher and used public health services more (p < 0.001), than their counterparts from states with weak health care system. Similarly, those in the urban or peri-urban localities used public health services more (p = 0.013). The two perceptual variables significantly influence the rating and use of public health services. Those with a good perception of the quality of health service provided, rated and patronized them more (p < 0.001). Also, health centres that provide a high number of services enjoyed greater rating and patronage (p < 0.001 and p = 0.0524 respectively). The results of the structured questionnaire survey were confirmed by qualitative enquiry,based on in-depth interviews and focus group discussions. Conclusions It will be necessary to create a more responsive atmosphere in the health facilities, with culturally-sensitive and friendly health workers, and provision of affordable drug to improve the perceptions of the primary health care system, for it to succeed in providing health services for all.
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Affiliation(s)
- Nkechi G Onyeneho
- Department of Sociology/Anthropology, University of Nigeria, Nsukka, Nigeria. .,Takemi Program in International Health, Department of Global Health and Population, Harvard T.H, Chan School of Public Health, Harvard University, Boston, MA, USA.
| | - Uche V Amazigo
- , P.O.Box 3397, Main Post Office, Okpara Avenue, Enugu, Nigeria.
| | - Ngozi A Njepuome
- , P.O.Box 7117, Wuse, Abuja, Federal Capital Territory, Nigeria.
| | - Obioma C Nwaorgu
- Department of Parasitology, Nnamdi Azikiwe University, Awka, Nigeria.
| | - Joseph C Okeibunor
- Department of Sociology/Anthropology, University of Nigeria, Nsukka, Nigeria. .,Immunization, Vaccines and Emergencies, WHO Regional Office for Africa, Brazzaville, Congo.
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14
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Okeibunor JC, Ota MC, Akanmori BD, Gumede N, Shaba K, Kouadio KI, Poy A, Mihigo R, Salla M, Moeti MR. Polio eradication in the African Region on course despite public health emergencies. Vaccine 2015; 35:1202-1206. [PMID: 26303876 DOI: 10.1016/j.vaccine.2015.08.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 08/05/2015] [Indexed: 10/23/2022]
Abstract
The World Health Organization, African Region is heading toward eradication of the three types of wild polio virus, from the Region. Cases of wild poliovirus (WPV) types 2 and 3 (WPV2 and WPV3) were last reported in 1998 and 2012, respectively, and WPV1 reported in Nigeria since July 2014 has been the last in the entire Region. This scenario in Nigeria, the only endemic country, marks a remarkable progress. This significant progress is as a result of commitment of key partners in providing the much needed resources, better implementation of strategies, accountability, and innovative approaches. This is taking place in the face of public emergencies and challenges, which overburden health systems of countries and threaten sustainability of health programmes. Outbreak of Ebola and other diseases, insecurity, civil strife and political instability led to displacement of populations and severely affected health service delivery. The goal of eradication is now within reach more than ever before and countries of the region should not relent in their efforts on polio eradication. WHO and partners will redouble their efforts and introduce better approaches to sustain the current momentum and to complete the job. The carefully planned withdrawal of oral polio vaccine type II (OPV2) with an earlier introduction of one dose of inactivated poliovirus vaccine (IPV), in routine immunization, will boost immunity of populations and stop cVDPVs. Environmental surveillance for polio viruses will supplement surveillance for AFP and improve sensitivity of detection of polio viruses.
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Affiliation(s)
- Joseph C Okeibunor
- Polio Eradication Programme, Regional Directors' Office, WHO/AFRO, Brazzaville, Congo.
| | - Martin C Ota
- Health Systems & Services, WHO/AFRO, Brazzaville, Congo
| | | | - Nicksy Gumede
- Polio Eradication Programme, Regional Directors' Office, WHO/AFRO, Brazzaville, Congo
| | - Keith Shaba
- Polio Eradication Programme, Regional Directors' Office, WHO/AFRO, Brazzaville, Congo
| | - Koffi I Kouadio
- Polio Eradication Programme, Regional Directors' Office, WHO/AFRO, Brazzaville, Congo
| | - Alain Poy
- Polio Eradication Programme, Regional Directors' Office, WHO/AFRO, Brazzaville, Congo
| | - Richard Mihigo
- Immunization & Vaccine Preventable Diseases Mbaye, WHO/AFRO, Brazzaville, Congo
| | - Mbaye Salla
- Polio Eradication Programme, Regional Directors' Office, WHO/AFRO, Brazzaville, Congo
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Okeibunor JC, Abiose A, Onwujekwe OE, Mohamed NA, Adekeye O, Ogungbemi MK, Amazigo UV. The rapid monitoring of ivermectin treatment: will school-based surveys provide the answer? Annals of Tropical Medicine & Parasitology 2013; 99:771-9. [PMID: 16297290 DOI: 10.1179/136485905x65143] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The data on ivermectin-treatment coverage recorded in household surveys sometimes conflict with those recorded in school-based surveys or in the relevant treatment registers maintained by community-directed distributors (CDD). An attempt has now been made, in two sites in Nigeria (Enugu and Kaduna states) and one in Sudan (Abu Hamad province), to determine how well these three sets of data are correlated (and to explore the effectiveness of several alternative channels for the delivery of treatment-monitoring forms to schools). Using a cross-sectional approach, data were collected from primary schools, households and treatment registers. Calculation of Pearson's correlation coefficients (r) indicated that, overall, the data from the household surveys were very similar to those collected using the school-based strategy (r=0.66; P<0.0001) or from the treatment registers of the CDD (r=0.86; P<0.0001). The information recorded in the CDD registers also closely matched that recorded in the school-based surveys (r=0.67; P<0.0001). These encouraging results for the pooled data masked some inter-site differences. The correlation between the household-survey and treatment-register data was, for example, only good in Enugu (r=0.89; P<0.001), and was too weak to be statistically significant in Abu Hamad or Kaduna. Although the results of the school-based survey in Kaduna also did not closely correlate with those of the corresponding household survey (r=0.10; P=0.71), the household survey at this site was probably not conducted as well as those at the two other sites. In general, it appears that school-based surveys are an effective means of monitoring community coverage with ivermectin, rapidly, accurately and at relatively low cost. It is therefore recommended that school-based methods of monitoring of coverage are adopted by programme managers.
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Affiliation(s)
- J C Okeibunor
- Department of Sociology and Anthropology, University of Nigeria, Nsukka, Nigeria.
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16
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Okeibunor JC, Akanmori BD, Balcha GM, Mihigo R, Vaz RM, Nshimirimana D. Enhancing access to immunization services and exploiting the benefits of recent innovations in the African region. Vaccine 2013; 31:3772-6. [PMID: 23800541 DOI: 10.1016/j.vaccine.2013.06.038] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Revised: 05/11/2013] [Accepted: 06/11/2013] [Indexed: 11/28/2022]
Abstract
The African Regional Office of the World Health Organization (WHO AFRO) organized the annual regional conference on immunization (ARCI) from 10 to 12 December 2012 in Dar es Salaam, Tanzania, under the theme, "Innovations, access and the right of all to vaccines". The meeting reviewed the status of immunization in the region and identified all innovations, strategies and technologies available and how these could be fully utilized to enhance the access and the rights of all to vaccines. Over 50 oral presentations were made in plenary and parallel sessions of the conference which was attended by over 200 participants drawn from national immunization programs, academia, public health experts and immunization partners. In addition there were 40 poster presentations. This manuscript summarizes of the meeting, highlighting the innovations in immunization being piloted or scaled-up, their impact and suggesting ways to further improve immunization service delivery for the eradication, elimination and control of vaccine-preventable diseases in the region.
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Affiliation(s)
- J C Okeibunor
- Immunization and Vaccines Development Cluster, WHO Regional Office for Africa, Box 06 Djoue, Brazzaville, Congo.
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Okeibunor JC, Brieger WR, Abiose AO, Elhassan E, Ndyomugyenyi R, Wanji S, Amazigo UV. Intention to Continue with Ivermectin Treatment for Onchocerciasis Control after Eight Years of Annual Distribution in Cameroon, Nigeria, and Uganda. Int Q Community Health Educ 2013; 33:159-73. [DOI: 10.2190/iq.33.2.e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This study identified the socio-demographic correlates of intention to comply with ivermectin treatment, from a structured interview of 2,306 persons aged 10 years and above, grouped into high and low compliers, who took ivermectin 6–8 times and 0–2 times respectively. Simple descriptive statistics were employed in characterizing the respondents into high and low compliers, while some socio-demographic and key perceptual factors were employed in regression models constructed to explain levels of compliance among the respondents. Demographic and perceptual factors associated with intention to comply with prolonged treatment with ivermectin were identified. Intention to comply was higher among married persons (91.8%, p < 0.001); local populations (89.8%, p < 0.001); and those with history of complying with treatment (98.2%, p < 0.001). Perception of onchocerciasis and effectiveness of ivermectin influenced intention to continue. The perceptual factors that drive the intention to comply should inform plans for health education at the project and village levels.
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Affiliation(s)
| | | | | | | | | | - Samuel Wanji
- Research Foundation in Tropical Diseases and Environment, Buea, Cameroon
| | - Uche V. Amazigo
- African Programme for Onchocerciasis Control, Ouagadougou, Burkina Faso
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18
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Brieger WR, Okeibunor JC, Abiose AO, Ndyomugyenyi R, Wanji S, Elhassan E, Amazigo UV. Characteristics of persons who complied with and failed to comply with annual ivermectin treatment. Trop Med Int Health 2012; 17:920-30. [PMID: 22575028 DOI: 10.1111/j.1365-3156.2012.03007.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess individual compliance with annual ivermectin treatment in onchocerciasis-endemic villages. METHODS Multi-site study in eight APOC-sponsored projects in Cameroon, Nigeria and Uganda to identify the socio-demographic correlates of compliance with ivermectin treatment. A structured questionnaire was administered on 2305 persons aged 10 years and above. Two categories of respondents were purposively selected to obtain both high and low compliers: people who took ivermectin 6-8 times and 0-2 times previously. Simple descriptive statistics were employed in characterizing the respondents into high and low compliers, while some socio-demographic and key perceptual factors were employed in regression models constructed to explain levels of compliance among the respondents. RESULTS Some demographic and perceptual factors associated with compliance were identified. Compliance was more common among men (54.4%) (P < 0.001). Adults (54.6%) had greater rates of high compliance (P < 0.001. The mean age of high compliers (41.5 years) was significantly older (35.8 years) (t = 8.46, P < 0.001). Perception of onchocerciasis and effectiveness of ivermectin influenced compliance. 81.4% of respondents saw benefits in annual ivermectin treatment, high compliance among those who saw benefits was 59.3% compared to 13.3% of those who did not (P < 0.001). CONCLUSION Efforts to increase compliance with ivermectin treatment should focus on providing health education to youth and women. Health education should also highlight the benefits of taking ivermectin.
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Affiliation(s)
- William R Brieger
- Department of International Health, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
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19
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Okeibunor JC, Orji BC, Brieger W, Ishola G, Otolorin E', Rawlins B, Ndekhedehe EU, Onyeneho N, Fink G. Preventing malaria in pregnancy through community-directed interventions: evidence from Akwa Ibom State, Nigeria. Malar J 2011; 10:227. [PMID: 21819579 PMCID: PMC3161917 DOI: 10.1186/1475-2875-10-227] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2011] [Accepted: 08/05/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite massive anti-malaria campaigns across the subcontinent, effective access to intermittent preventive treatment (IPTp) and insecticide-treated nets (ITNs) among pregnant women remain low in large parts of sub-Saharan Africa. The slow uptake of malaria prevention products appears to reflect lack of knowledge and resistance to behavioural change, as well as poor access to resources, and limited support of programmes by local communities and authorities. METHODS A recent community-based programme in Akwa Ibom State, Nigeria, is analysed to determine the degree to which community-directed interventions can improve access to malaria prevention in pregnancy. Six local government areas in Southern Nigeria were selected for a malaria in pregnancy prevention intervention. Three of these local government areas were selected for a complementary community-directed intervention (CDI) programme. Under the CDI programme, volunteer community-directed distributors (CDDs) were appointed by each village and kindred in the treatment areas and trained to deliver ITNs and IPTp drugs as well as basic counseling services to pregnant women. FINDINGS Relative to women in the control area, an additional 7.4 percent of women slept under a net during pregnancy in the treatment areas (95% CI [0.035, 0.115], p-value < 0.01), and an additional 8.5 percent of women slept under an ITN after delivery and prior to the interview (95% CI [0.045, 0.122], p-value < 0.001). The effects of the CDI programme were largest for IPTp adherence, increasing the fraction of pregnant women taking at least two SP doses during pregnancy by 35.3 percentage points [95% CI: 0.280, 0.425], p-value < 0.001) relative to the control group. No effects on antenatal care attendance were found. CONCLUSION The presented results suggest that the inclusion of community-based programmes can substantially increase effective access to malaria prevention, and also increase access to formal health care access in general, and antenatal care attendance in particular in combination with supply side interventions. Given the relatively modest financial commitments they require, community-directed programmes appear to be a cost-effective way to improve malaria prevention; the participatory approach underlying CDI programmes also promises to strengthen ties between the formal health sector and local communities.
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Affiliation(s)
- Joseph C Okeibunor
- Department of Sociology/Anthropology, University of Nigeria, Nsukka, Nigeria
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20
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Brieger WR, Okeibunor JC, Abiose AO, Wanji S, Elhassan E, Ndyomugyenyi R, Amazigo UV. Compliance with eight years of annual ivermectin treatment of onchocerciasis in Cameroon and Nigeria. Parasit Vectors 2011; 4:152. [PMID: 21794139 PMCID: PMC3162569 DOI: 10.1186/1756-3305-4-152] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2011] [Accepted: 07/27/2011] [Indexed: 11/30/2022] Open
Abstract
Background As the African Programme for Onchocerciasis Control (APOC) matured into its 10th year of ensuring community involvement in mass annual treatment of onchocerciasis with ivermectin, there was recognition of a need to study not only annual coverage of ivermectin in villages but also the compliance of individual villagers with these annual treatments. This was based on the concern that while population coverage goals may be achieved each year, there might be segments of the population who systematically are not complying with the annual regimen, thus creating a reservoir of infection and threatening program gains. Methods A multi-site study in five APOC sponsored projects in Nigeria and Cameroon was undertaken to identify the socio-demographic correlates of compliance with ivermectin treatment. A total of 8,480 villagers above 9 years of age selected through a systematic random sampling from 101 communities were surveyed to ascertain their levels of compliance, by adapting APOC's standard household ivermectin survey form. Community leaders, community directed distributors (CDDs) of ivermectin and health workers were interviewed with in-depth interview guides, while focus group discussions were held with community members to help explain how socio-demographic factors might affect compliance. Results Eight-year compliance ranged from 0 to 8 times with 42.9% taking ivermectin between 6-8 times annually (high compliance). In bivariate analysis high compliance was positively associated with being male, over 24 years of age, having been married, not being Christian, having little or no formal education and being in the ethnic majority. These variables were also confirmed through regression analysis based on total times ivermectin was taken over the period. While these factors explained only 8% of the overall variation in compliance, ethnic status and education appeared to be the strongest factors. Those with higher education may be more mobile and harder to reach while neglect of ethnic minorities has also been documented in other programs. Conclusion These findings can help managers of CDTI programmes to ensure ivermectin reaches all segments of the population equally.
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Affiliation(s)
- William R Brieger
- Department of International Health, The Johns Hopkins UniversityBloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD 21014, USA
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Amuyunzu-Nyamongo M, Tchounkeu YFL, Oyugi RA, Kabali AT, Okeibunor JC, Manianga C, Amazigo UV. Drawing and interpreting data: Children's impressions of onchocerciasis and community-directed treatment with ivermectin (CDTI) in four onchocerciasis endemic countries in Africa. Int J Qual Stud Health Well-being 2011; 6:QHW-6-5918. [PMID: 21637349 PMCID: PMC3105904 DOI: 10.3402/qhw.v6i2.5918] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/18/2011] [Indexed: 11/14/2022] Open
Abstract
Although the depiction of a child leading a blind man is the most enduring image of onchocerciasis in Africa, research activities have hardly involved children. This paper aims at giving voice to children through drawings and their interpretation. The study was conducted in 2009 in Cameroon, Democratic Republic of Congo (DRC), Nigeria and Uganda. Children aged 6-16 years were asked to draw their perceptions of onchocerciasis and community-directed treatment with ivermectin (CDTI) in their communities. A total of 50 drawings were generated. The drawings depicted four main aspects of onchocerciasis: (1) the disease symptoms, (2) the negative consequences of onchocerciasis among children and in the community generally, (3) the ivermectin distribution process, and (4) the benefits or effects of taking ivermectin. Out of the 50 drawings, 30 were on symptoms, 7 on effects of the disease on children, 8 on distribution process, and 5 represented multiple perceptions on symptoms, drug distribution processes, benefits, and effects of treatment. The lack of clarity when treatment with ivermectin can be stopped in endemic areas requires working with children to ensure continued compliance with treatment into the future. Children's drawings should be incorporated into health education interventions.
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Okeibunor JC, Amuyunzu-Nyamongo M, Onyeneho NG, Tchounkeu YFL, Manianga C, Kabali AT, Leak S. Where would I be without ivermectin? Capturing the benefits of community-directed treatment with ivermectin in Africa. Trop Med Int Health 2011; 16:608-21. [DOI: 10.1111/j.1365-3156.2011.02735.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Okeke TA, Okeibunor JC. Rural–urban differences in health-seeking for the treatment of childhood malaria in south-east Nigeria. Health Policy 2010; 95:62-8. [DOI: 10.1016/j.healthpol.2009.11.005] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2009] [Revised: 11/02/2009] [Accepted: 11/05/2009] [Indexed: 11/27/2022]
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Okeibunor JC, Onyeneho NG, Chukwu JN, Post E. Barriers to care seeking in directly observed therapy short-course (DOTS) clinics and tuberculosis control in southern Nigeria: a qualitative analysis. Int Q Community Health Educ 2008; 27:23-37. [PMID: 18039627 DOI: 10.2190/iq.27.1.c] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
An understanding of the socioeconomic and cultural realities of persons infected with tuberculosis (TB) in communities is important to re-strategizing control programs because these realities often come as constraints to the use of the directly observed therapy short-course (DOTS) in Nigeria. In-depth interviews and focus group discussion were used to study barriers to attendance at DOTS clinics for both prompt diagnosis and treatment of smear positive cases in Nigerian communities. A number of common and interrelated factors form barriers to use of DOTS clinics. These include perceived causes of the infection, for example witchcraft, that mitigate against an orthodox solution to TB and thereby affect perceived efficacy of DOTS. Another factor is perceived high cost in resource poor settings. Facility staff were noted to have demanded money from patients in spite of the fact that DOTS is advertised as free treatment. Furthermore, community members complain of the hostile attitude of health staff toward poor people as a barrier to community use of the facilities. It follows, therefore, that the attitude of health workers must be addressed if community members will use the DOTS clinics.
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Okeibunor JC, Onyeneho NG, Chukwu JN, Post E. Where do tuberculosis patients go for treatment before reporting to DOTS clinics in southern Nigeria? ACTA ACUST UNITED AC 2007; 9:94-101. [PMID: 17722411 DOI: 10.4314/thrb.v9i2.14310] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Health-seeking patterns of persons with tuberculosis (TB) before reporting at the Directly Observed Treatment Short-course (DOTS) clinic for diagnosis and treatment were analysed. A total of 221 persons registered in the DOTS programme in 12 randomly selected rural and urban Local Government Areas in southern Nigeria were interviewed using a semi-structured questionnaire. Perceived causes of TB influenced first choice of treatment. Patients re-evaluated initial choices and shop for alternatives in persistent TB. Chemists were the first port of call for most patients. Those with unscientific causative theories of tuberculosis such as witchcraft engaged more in multiple health-seeking than those who indicated bacterial infection (P < 0.0001). The respondents had a median diagnostic-delay of 90 days. Delay in commencement of DOTS treatment was attributable to ignorance among patients and poor attitude of health workers. In conclusion, delay exists between recognition of symptoms and initiation of treatment in DOTS clinics partly because of ignorance among patients. Health workers' attitude to patients reporting at health clinics also discouraged the use of DOTS facilities. Consequently, it is recommended to address such delay through social mobilization of communities and through engaging Chemists in TB service delivery in this area.
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Affiliation(s)
- J C Okeibunor
- Department of Sociology/Anthropology, University of Nigeria, Nsukka, Enugu State, Nigeria.
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Brieger WR, Okeibunor JC, Abiose AO, Ndyomugyenyi R, Kisoka W, Wanji S, Elhassan E, Amazigo UV. Feasibility of measuring compliance to annual ivermectin treatment in the African Programme for Onchocerciasis Control. Trop Med Int Health 2007; 12:260-8. [PMID: 17300634 DOI: 10.1111/j.1365-3156.2006.01796.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The African Programme for Onchocerciasis Control (APOC) sponsors annual distribution of ivermectin to control onchocerciasis. Ivermectin should be taken annually by 65% of community members for a number of years to eliminate the disease as a public health problem. While many community coverage surveys have been undertaken during project monitoring, individual compliance could not be studied until several annual rounds of distribution had occurred. This paper reports on the efforts to determine whether adequate records could be found to enable a compliance study. A step-down process from project to district to community level was used to identify project sites where continuous ivermectin distribution up through 2004 had occurred. The first step consisted of selecting 17 of 25 projects by APOC. The second step determined adequacy of districts where distribution had occurred on a regular annual basis. Among 121 districts 58.6% undertook distribution in all 7 years. A total 852 villages were visited and community level records were found in all but three. Records showed that distribution had occurred for a minimum of five consecutive times in 429 villages, and ultimately 10 projects. While the feasibility study found an adequate number of villages to study compliance, the large number of projects, districts and villages that did not qualify for the follow-on compliance study should lead National Onchocerciasis Control Programme managers to strengthen the overall coverage and consistency of their efforts.
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Affiliation(s)
- William R Brieger
- Department of International Health, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21014, USA.
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Okeibunor JC, Ogungbemi MK, Sama M, Gbeleou SC, Oyene U, Remme JHF. Additional health and development activities for community-directed distributors of ivermectin: threat or opportunity for onchocerciasis control? Trop Med Int Health 2004; 9:887-96. [PMID: 15303994 DOI: 10.1111/j.1365-3156.2004.01285.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We studied the involvement of community-directed distributors (CDDs) of ivermectin for onchocerciasis control in other health and development activities in Nigeria, Togo and Cameroon. Most CDDs (82%) were involved in additional activities, especially EPI, water and sanitation and community development projects. These activities did not take up much time and were not considered an important burden. Ivermectin treatment coverage did not decline with increasing number of additional activities. Other health programmes are interested in building on the experiences and structures of community-directed treatment with ivermectin and involving CDDs in their health programmes. Some, such as EPI, provide financial incentives. Incentives by other programmes may enhance the performance of CDDs when they are selected on the basis of their CDD status. CDDs, health personnel and community members have very positive attitudes towards greater involvement of CDDs in additional health and development activities. We conclude that additional activities for CDDs do not pose a threat to but rather provide an opportunity to strengthen sustainability and effectiveness of ivermectin treatment.
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Affiliation(s)
- Joseph C Okeibunor
- Department of Sociology/Anthropology, University of Nigeria, Nsukka, Nigeria.
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Ogbonnaya LU, Okeibunor JC. Sociocultural Factors Affecting the Prevalence and Control of Lymphatic Filariasis in Lau Local Government Area, Taraba State. Int Q Community Health Educ 2004. [DOI: 10.2190/ay5a-qay4-6h8d-vel7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The Health Belief Model (HBM) and the Structural Basis for Health Action theories were employed in assessing the factors associated with the prevalence of lymphatic filariasis (LF) and the feasibility of a control program using a mass chemotherapy approach, in Lau Local Government Area of Taraba State, Nigeria. Two communities with health facilities and one without a health facility were studied in 2003. A modified version of the WHO cluster sampling technique was used in the random selection of respondents. Clinical examination, questionnaire survey, focus group discussion and key informant interview techniques were used in collecting the data. LF, involving elephantiasis and hydrocoele, is perceived as a severe disease in the communities, being ranked the 2nd and 3rd most severe respectively among the ten most common diseases in the communities. However a low perception of personal susceptibility to LF was identified among the people. The study also found serious gaps in understanding between knowledge of the cause of the disease and the means of its transmission. Very few people associated LF with mosquito bites. The treatments available and used by the people are predominantly traditional (scarifications and application of herbal preparations). Effective alternatives provided by the health system were lacking, even though about 97% of the people indicated willingness to take part in a mass chemotherapy program for the control of the disease. The two theories were useful in explaining the widespread prevalence of LF in the community and in understanding the health behavior of the people faced with the challenge of such a debilitating and stigmatizing disease. The health system has failed to provide an effective program to eliminate the disease. In the absence of a control or elimination program for LF, the people make use of traditional treatments both because of limited knowledge with regard to LF and the lack of effective care for those already affected and not because of lack of belief in the efficacy of modern treatment.
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Abstract
There is limited data on the prevalence of onchocerciasis in young children in Nigeria, partly because treatment with the effective drug Ivermectin has been contra-indicated in children less than 5. As the risk of complications of onchocerciasis is related to duration and intensity of infection, it would be beneficial to know the prevalence in young children for design of control programmes. A study was therefore undertaken to determine the prevalence of onchocerciasis in 642 children 0-4 years old in a rain forest endemic community in South East Nigeria. The overall onchocerciasis prevalence (positive skin snips) for children 0-4 years old in three Local Government Areas in Enugu State, Eastern Nigeria was 15.7% with no significant difference in infection rates between male and female children. There was no detectable infection in children less than 1 year old. Characteristic onchocercal rash was identified in 11.1% of the children and presence of typical onchocercal subcutaneous palpable nodules in 4.6%. Total prevalence for adults in the same population was found to be 26.9%. This indicates that in onchocerciasis endemic communities, everybody may be at risk of infection irrespective of age.
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Affiliation(s)
- O C Nwaorgu
- Department of Biological Science, Nnamdi Azikwe University, Awka, Nigeria
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Amazigo UO, Anago-Amanze CI, Okeibunor JC. Urinary schistosomiasis among school children in Nigeria: consequences of indigenous beliefs and water contact activities. J Biosoc Sci 1997; 29:9-18. [PMID: 9881116 DOI: 10.1017/s0021932097000096] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
A study of urinary schistosomiasis in Umueze-Anam, Anambra State, Nigeria, showed a Schistosoma haematobium infection of 26% (85) among school children with no significant difference by sex except when age as a variable is introduced. Eleven percent (37) of the 333 children were positive for haematuria; all these 37 children lived within 1.0 km of the water sources. Of the 85 infected children, swimming and laundering accounted for 65% and 48% of all water contact activities, for boys and girls respectively. One-third of the 230 adults interviewed believed haematuria to be a venereal disease and 20% thought it was a sign of maturity. Individual perception of causation and seriousness of haematuria differed by level of education and by sex. Less than 2% of the respondents knew that snails transmitted the disease. The effects of social restrictions on the epidemiology of infection is discussed.
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Affiliation(s)
- U O Amazigo
- Department of Zoology, University of Nigeria, Nsukka, Nigeria
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Okeibunor JC, Asobie FC, Igboeli CC. Factors Associated with the Use of SSS among Mothers in Nsukka Zone of Enugu State, Nigeria. Int Q Community Health Educ 1994; 15:127-36. [DOI: 10.2190/hwl9-vfcj-df5h-x7g3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The study was designed to identify factors influencing mothers' use of SSS in the management of diarrhoea in children. A survey questionnaire was used and a total of 652 mothers drawn from both rural and urban communities were interviewed. The two perceptual factors, perceived seriousness of diarrhoea and perceived efficacy of salt sugar solution (SSS) were found to relate significantly with SSS use. Similar associations were found between knowledge of SSS preparation and beliefs about diarrhoeal illness causation. Of the three demographic factors tested, only one, education, showed potential for influencing SSS use. Religion and residence (rural, urban) were not found to be predictors of SSS use. The positive association of clinic use (as measured by place where the mother gave birth to her last child) with SSS points to the need to improve the quality of facility-based health education with special focus on improving knowledge of SSS preparation procedures and perception of SSS efficacy.
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